Mr Richard Maw, consultant ear, nose and throat surgeon at the Royal Hospital for Sick Children, Bristol, has been testing a new treatment for glue ear. Each year, thousands of children who suffer from the condition undergo surgery to have grommets inserted in their ears. However, in a trial of 85 children, Mr Maw found that regular 'auto-inflation' exercises - blowing up a special balloon through one nostril - can delay or even eliminate the need for surgery.
The treatment is simple. The child is given a white balloon that has a hard round teat. With pressure from his finger, he closes one nostril, puts the teat in the other, and tries to inflate the balloon. The intention is to make his ears 'pop'. If successful, the child will significantly increase the pressure inside his nose and in the cavity of the nasopharynx behind. This drives air along the Eustachian tube, which leads from the back of the throat to the ear and which becomes blocked in cases of glue ear.
Scientists have known for centuries that applying gentle pressure on the middle ear is a good way of clearing the system. Pinching the nose and blowing out the cheeks against sealed lips was first described by Valsalva, an 18th-century physician. But Valsalva's Manoeuvre is difficult to describe to children, and it is even harder to tell if they are performing the exercise correctly. The idea of a nose balloon was developed by doctors in Copenhagen last year, and the result, known as Otovent, is now available here.
Ben Bartlett, a nine-year-old from Bristol, has suffered from glue ear since he was an infant. He had grommets fitted when he was two and a half. These improved his hearing immediately, says his mother, Amanda, but the effect eventually wore off. 'Ben's right ear is his problem. Sometimes he screams with the pain. It is excruciating and nothing seems to help him.'
At Mr Maw's clinic, Ben gave the nose balloon a try and reported straight away that he noticed hearing again in his bad ear. 'We want Ben to blow up the balloon three times a day for a few weeks or even months,' says Mr Maw. 'We'll keep him on the list for another grommets operation, but he may be able to get rid of the glue by himself before then.'
Mr Maw's research shows that the balloon is indeed useful. 'If a child is able to comply with the treatment, there is a two to five times improvement in resolution of middle-ear fluid,' he says. 'Naturally, older children were able to comply more easily than younger children.'
To be effective, the nose balloon must be used every day, except when the child has a cold. The Otovent kit comes with a stick-on puzzle that the child completes when a full course of exercises is done.
Earache and blocked middle ear are common in young children, though most of them eventually grow out of their suffering. The 'glue' is a sticky fluid that collects in the middle ear, often after an infection in winter. About a quarter of all children in this country suffer from glue ear at least once before the age of five.
Left alone, glue ear usually clears up in three months. But in 10 per cent of children the condition becomes chronic. 'When glue ear affects both ears, there can be a significant effect on the child's speech, language and learning ability. Their school work, in particular reading, can suffer,' Mr Maw says. Behaviour can deteriorate, and the child becomes increasingly isolated in a semi-silent world.
Inserting grommets, which requires a general anaesthetic, is the favoured treatment for glue ear. These small tubes, which are inserted through the eardum, equalise the pressure, with the result that fluid drains down the Eustachian tube into the back of the throat. There are 60,000 grommet operations every year in England and Wales.
Before 1954, when the operation was introduced, the only option was to remove the tonsils and/or adenoids, or carry out simple drainage of the ear, which had only a short-lived effect. While the grommets operation can transform a child's life, it still attracts controversy, with some specialists arguing against putting thousands of children through what they call 'unnecessary surgery'.
Mr Maw calculates that grommet insertion costs about pounds 475, and that the operation is repeated in 30 per cent of cases. He says grommets are 'terribly effective' when given to the right children. His clinic insists on rigorous screening before surgery is recommended.
The nose balloon now gives patients some practical help while they wait for an operation, and may have an impact upon mass surgery. So far, the Bristol trial, though the longest conducted on the nose balloon, can only show what may be achieved over three months.
'Some lack of enthusiasm was perceived towards the end of the treatment, indicating that compliance may be a problem if used continuously over long periods,' say the Bristol researchers in their paper on the study, published earlier this year in Clinical Otolaryngology.
In other words, the children, particularly younger ones, grew bored.
Otovent is available from chemists for approximately pounds 6. It may be prescribed by some hospital pharmacies. It is not available through GPs on prescription.
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